Active NPI
Victoria A Eshietedoho, PHARMACIST
- Pharmacist
- Lake City, FL
National Provider Identifier
1659985000
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PS54432
- Practice address
- 2094 W US Highway 90
Lake City, FL 32055-4720 - Phone
- (386) 755-0313
- Fax
- (386) 755-5994
- NPI assigned
- Sep 3, 2020
- Last updated
- Sep 3, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PS54432 | FL | Primary |
Addresses
Primary practice location
2094 W US Highway 90
Lake City, FL 32055-4720
Mailing address
1488 Autumn Pines Dr
Orange Park, FL 32065-2716
Phone (954) 665-7136
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS54432 | FL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599091200000",
"number": "1659985000",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1488 AUTUMN PINES DR",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320652716",
"telephone_number": "954-665-7136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2094 W US HIGHWAY 90",
"city": "LAKE CITY",
"state": "FL",
"postal_code": "320554720",
"telephone_number": "386-755-0313",
"fax_number": "386-755-5994"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ESHIETEDOHO",
"first_name": "VICTORIA",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "PHARMACIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-09-03",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "FL",
"license": "PS54432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.